Needless Needles?

By Owen C. Franklin

I had some concerns when I first thought about the pump. I thought 'Oh my God, I'm going to feel like a cyborg.'

Tory Miller watched her father struggle and die from diabetes.

"When my father died, he was blind, he had neuropathy, he had heart complications," said Miller. "They just didn’t have the tools to fight the disease."

Now, she’s waging her own battle against the same illness.

"I’m working my ass off not to die of diabetes complications when I’m fifty like my dad," said Miller. "I’m just as brittle as he was."

Miller, however, has a critical advantage. Decades of medical progress have brought life-saving tools to people with diabetes.

"I’ve made so many changes in my diabetes plan," said Miller. "The amount of information I have is just so much more than the generation before."

Today, Miller is considering what may be the next generation of diabetes care. Within a matter of days, she could swap daily injections for a pocket-sized tool called the insulin pump.

Routine injections of insulin can disrupt a person’s schedule, not to mention a person’s life. These treatments require careful timing, and can be embarrassing when performed in public.

Here’s where the insulin pump comes in. A small dispenser, the size of a beeper or wallet, holds a reservoir of insulin. An automatic pump dispenses the insulin into a flexible plastic tube. This tube connects to tissue below the skin to deliver insulin directly into the body.

With the pump, people with diabetes can bid farewell to the daily "time-outs" that are needed to load a syringe and perform an injection.

"There is more flexibility," said Leonid Poretsky M.D., Director of the Diabetes Center of Cornell University Medical College. "It’s really good for people with active lifestyles for whom regular injections are inconvenient."

Throughout the day, the pump dispenses continual doses of insulin — called the basal rate. At meal times, the pump dispenses a larger dose — called the bolus rate.

The dispenser can be easily detached for such activities as showering and swimming. The tube can be detached as well, but is more difficult to re-insert.

A physician or diabetes educator will work with a person to determine his/her insulin needs and to program the dispenser.

This treatment, however, doesn’t come without a price tag. The pump itself can cost up to 5,000 dollars and the supplies such as tubing, needles, tape and batteries can add up to 50 dollars a month. Fortunately, many insurance companies will cover up to 80 percent of the cost.

The pump may seem an ideal solution, but it has its drawbacks.

"There was a while where I wondered if I could do it, if I could learn all the technological functions," said Miller. "And even if I do, what if it fails?"

While mechanical problems within the dispenser are rare, problems in the plastic tube are more common. A kink or bend in the plastic tube can block the flow of insulin. If this problem is not recognized, it can lead to health problems such as hypoglycemia.

"It’s a machine," said Dr. Poretsky. "Any machine can malfunction."

Because of this risk, glucose monitoring is crucial when using the insulin pump. Many people with diabetes, however, simply do not perform these critical tests. Drawing blood can be painful and time consuming, and some people feel they understand the patterns of their illness and don’t need to test.

According to doctors, these people are not ideal candidates for the insulin pump. People who don’t monitor their glucose levels should — at least — be positive that they are getting regular doses of insulin. This level of control may be hard to achieve with a machine.

"If a person wants to use the pump, they have to be willing to monitor [glucose levels]," said Dr. Poretsky, "If they don’t they can end up in trouble."

For some people, inviting a mechanical device into the delicate workings of the body is an unsettling notion.

"I had some concerns when I first thought about the pump," said Miller. "I thought ‘Oh my God, I’m going to feel like a cyborg.’"

Concerns such as this, according to experts, tend to fade as a patient gets used to the pump.

"I’ve never had a patient stop using it," said Dr. Poretsky. "Often times, they forget that they are wearing it at all."

The strength of the insulin pump can be its greatest weakness. The complex technology that makes the pump possible intimidates some users.

"They have to be reasonably savvy with technology, " said Dr. Poretsky. "There are buttons and programs you have to deal with."

But for many people with diabetes, technology is the best weapon against their disease. Tory Miller is one of those people. By keeping track of medical advances, Miller has ensured a quality of life her father never had the chance to enjoy.

"I want to worry less about how diabetes is going to fit in to the way I want to live my life," said Miller. "If I follow the rules, I’ll be able to behave like I don’t even have diabetes."

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